论文部分内容阅读
目的:研究外固定支架治疗掌指骨关节内骨折的疗效。方法:自2012年2月至2017年9月，我们采用Orthofix外固定支架（部分结合克氏针有限内固定）治疗掌指骨关节内骨折患者30例30指。术后第1天、1周、2周分别摄X线片复查，必要时可根据X线片结果再次调节外固定支架使骨折达到更好复位。结果:术后随访时间为6~72个月，平均22个月。1例失访于外固定支架拆除后。骨折临床愈合时间为平均7周。术后1例出现固定针松动，1例出现严重疼痛，4例发生关节僵硬，1例骨折畸形愈合，1例关节面缺损破坏、关节间隙明显狭窄，4例寒冷刺激耐受不良。末次随访采用手指总主动活动度（total active motion，TAM）法评定功能：优15例，良5例，中7例，差2例，优良率为69%。DASH评分平均4.2分，术后平均6周可回归工作和日常生活。结论:外固定支架（部分结合有限内固定）是治疗掌指骨关节内骨折有效、安全的方法。“,”Objective:To investigate the clinical efficacy of external fixators in the treatment of intra-articular fractures of the metacarpal and phalangeal bones.Methods:From February 2012 to September 2017, a total of 30 patients with intra-articular metacarpal or phalangeal fractures (30 fingers) were treated by external fixators (combined with limited internal fixation using Kirschner wire in some cases). X-ray films were taken at the first day, the first week and the second week after operation. If necessary, the external fixator could be adjusted again according to the results of X-ray films to achieve better reduction of the fractures.Results:The follow-up period ranged from 6 to 72 months with an average of 22 months. Follow-up lost occurred in 1 case after removal of the external fixator. The average clinical healing time of fracture was 7 weeks. After operation, 1 case had loosening of fixation pin, 1 case had severe pain, 4 cases had joint stiffness, 1 case had malunion of fracture, 1 case had damage of articular surface and obviously narrow joint space, 4 cases had poor tolerance to cold stimulation. In the last follow-up, total active motion (TAM) was used to evaluate the function. The results were rated as excellent in 15 cases, good in 5 cases, fair in 7 cases and poor in 2 cases, with the excellent and good rate being 69%. The mean DASH score was 4.2 and the average postoperative 6 weeks could return to work and daily life.Conclusion:External fixator (combined with limited internal fixation using Kirschner wire in some cases) is an effective and safe method for the treatment of intra-articular fractures of the metacarpal and phalangeal bones.